Withdrawal and Relapse
from Tobacco Use
Most people who are trying to stop smoking
will have some withdrawal symptoms. It helps
to remember that these symptoms are usually
temporary and mean that you are on the road to
recovery from tobacco use. Everyone responds
differently to withdrawal from smoking and tobacco
use. These reactions can range from mild cravings
to feelings of depression. Most likely you will
experience some difficulty in quitting, but there
will be positive rewards for your efforts as well.
What symptoms might I have after I
stop smoking?
Chest tightness: Tightness in your chest can be
caused by the body craving nicotine or it may
be sign of a more serious problem. Consult your
health care provider if this symptom occurs.
Concentration problems: Nicotine is a stimulant,
so some people find it helps with their
concentration. It may take one or two weeks for
your concentration to return to normal without
nicotine.
Constipation: Constipation may occur for a brief
time. It typically goes away in a week or two.
Drinking plenty of water will help. Eat whole
grains, fruits, and vegetables. Exercising may also
help.
Coughing/clearing your throat/dry throat/
postnasal drip: While you are smoking, your
body creates extra mucus to help rid your body
of the harmful chemicals in cigarettes. Coughing
andother symptoms are usually signs that your
body is in the stages of healing. For example,
when you stop smoking, you may produce
more mucus/phlegm than usual. This is normal.
Drinking plenty of water makes it easier for you
to cough out the mucus/phlegm,or sucking on
a hard candy may ease the discomfort of a dry
throat.
ATS Patient Education Series © 2013 American Thoracic Society
Craving a cigarette or tobacco: Cravings usually
only last a few minutes and decrease over time.
Keep that in mind as you work your way through
this period. Distract yourself by doing something
other than smoking (taking a walk, calling a
friend, reading a book, keeping activeworking on
a hobby, etc.).
Depression: It is not uncommon to have
symptoms of depression after quitting. Remind
yourself that stopping smoking will have
positive effects on your health and the health
of those around you. The negative feelings and
withdrawal symptoms will eventually pass. Talk
about your feelings and become involvedin
physical activity that suits your lifestyle.
Hunger: Cravings for nicotine can make you feel
like you are hungry. It is important not to replace
cigarettes or smokeless tobacco with food. Try to
drink extra fluids, eat a healthy diet and healthy
snacks. Plan ahead. Before you stop tobacco use,
get healthy foods you will eat at times when you
feel hungry.
Irritability or Anxiety: Your body’s craving for
nicotine may cause irritability after you stop
smoking. Irritability will lessen in about 2-4
weeks.Using nicotine replacement products
may help you make the transition to stopping
altogether and reduce irritability. Remember to
be patient with yourself because the benefits of
not smoking will be worth the effort.
Sleep difficulty: Nicotine can affect how deeply
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you sleep. Dreaming about smoking is common.
Taking a warm bath, avoiding caffeinated
beverages or products and deep breathingexercises
may help yousleep better.
Tiredness: Nicotine is a stimulant, so giving up
nicotine may give you a feeling of being tired
(fatigued).Feeling tired is your body’s reaction to
not having nicotine. Your energy will increase
as your body gets adjusted to not having heavy
doses of nicotine. Eating healthy foods and
avoiding sugar can help.
What should I do if I relapse?
If you relapse, stop smoking or using tobacco
products immediately. Get rid of any cigarettes
you may have. Recognize that you have had a
slip. You can recover from this small setback.
•Don’t be too hard on yourself.
•Get yourself on the non-smoking track again.
•Most smokers try to quit many times before
they are successful.
Identify the trigger that caused the relapse and
what prompted you to smoke or use tobacco
products. Decide how you will cope with that
trigger in the future.
What can I do to prevent relapse?
During a craving, remember the 5D’s.
1.Deep Breathing. A simple deep breathing
exercise can help you deal with tension.
2.Drink water. This will help decrease cravings.
3.Delay. Cravings fade away in a couple of
minutes. Try to wait it out. If you are using
nicotine replacement therapy, take some.
4.Do something else. Find something else to do
when you have the urge to smoke (exercise,
shower, change your routine, work on a hobby).
5.Discuss with a friend. Sometimes just talking
about the difficulty you are having will help
you deal with cravings.
Authors: Tobacco Control Committee of the American
Thoracic Society, Patricia Folan RN, DNP, Christine Fardellone,
RN, DNP, Andrea Spatarella, FNP-BC, DNP
Reviewers: Suzanne C. Lareau RN, MS
References:
New York State Smokers Quitline
http://www.nysmokefree.com/PageView.
aspx?P=20&l=E
Mayo Clinic for Lifestyle/Home Remedies
and Coping and Support:
http://www.mayoclinic.com/health/nicotinedependence/DS00307/Dsection=lifestyle-andhome-remedies
http://www.mayoclinic.com/health/nicotinedependence/DS00307/Dsection=coping-andsupport
US Department of Health and
Human Services.
A Report of the Surgeon General: How Tobacco
Smoke Causes Disease: What It Means to You.
US Department of Health and Human Services,
Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention
and Health Promotion, Office on Smoking and
Health, 2010.
Action Steps
If you are having withdrawal symptoms and
you would like help, call the quit smoking line.
If these withdrawal symptoms are disturbing to
you, call your health care provider. Talk to your
health care provider to find out if you are eligible
to use medications or nicotine replacement
products to help you quit.
✔Find a local cessation program by visiting
http://www.quitnet.com/library/programs/.
✔Call 1-800-QUITNOW (1-800-784-8669) for
telephone counseling and information about
quitting in your state.
✔Don’t give up, keep trying.
Health Care Provider’s Contact Numbers/
E-mail Address:
The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing
in this series is for educational purposes only and should not be used as a substitute for the medical advice one one’s personal health care
provider. For further information about this series, contact J.Corn at [email protected].
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